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Meningitis (mechanism of disease)

This is a flowchart on meningitis, covering the etiologies, pathophysiology, and manifestations. ADDITIONAL TAGS: Head trauma Neurosurgery Common causes: Risk factors / SDOH Cell / tissue damage Structural factors Meningitis Medicine / iatrogenic Infectious / microbial Biochem / organic chem Immunology / inflammation Signs / symptoms Tests / imaging / labs Environmental / toxins Neoplasm / cancer Flow physiology Pathophysiology Etiology Manifestations Infection / inflammation of the meninges (membranes surrounding the brain) CSF leak causing direct infection Contiguous spread from nose, eyes, ears Sinusitis Otitis media Hematogenous dissemination Maternal Group B Strep infection during birth Sepsis Retrograde transport along/within nerves Risk factors: Crowded occupational or living conditions College dorms Military barracks Retirement homes Kindergartens Immunocompromised AIDS Asplenia Heavy alcohol use Chronic illness Cancer Sickle cell Old age Pregnancy H flu B Listeria S pneumo Gram(-) bacilli (E coli, Salmonella) Basilar skull fracture Penetrating injury H flu B GAS S pneumo S aureus Coag(-) Staph (epi) Aerobic gram(-); Pseudom. GBS E. coli Listeria S. pneumo Neisseria m. GBS H flu B S. pneumo Neisseria m. S. pneumo E. coli Listeria H flu B Neisseria m. GBS 1 month 1mo - 2yr 2-50 yrs 50 yrs Viral: enterovirus (coxsackie, echo); herpes (HSV1,2; VZV), mumps, measles, flu Fungal: Coccidioides, Candida, Aspergillus Sarcoidosis Tumor mets NSAIDs, sulfa drugs Fever Headache Altered mental status Neck stiffness Photophobia Bacterial etiologies by age Classic triad Malaise, fatigue Nausea, vomiting +/- CN palsies Seizures Photophobia Myalgias Petechial, purpuric rash In case of N. meningitidis DIC Hemorrhagic necrosis of adrenals Adrenal insuff. Waterhouse-Friderichsen Flu-like prodrome Low-grade fever Sore throat Myalgias Herpangina Pharyngitis Viral rash Viral symptoms Encephalitis Inflammation Hypotension Tachycardia Fever Papilledema ↑ ICP Physical exam Brudzinski, Kernig signs Neonatal presentation: early: → late: Lethargy Irritability Muscle hypotonia Dysthermia Poor appetite Dyspnea Fontanelle bulging High- pitched crying Seizures ↑ Upwards Arrow 24 ↓ Downwards Arrow 25 → Rightwards Arrow 26 ← Leftwards Arrow 27 ↔ Left-Right Arrow 29 ↕ Up-Down Arrow 18